What are the treatment options for a patient with chronic interstitial cystitis (Chronic Cystitis)?

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Last updated: April 16, 2025 • View editorial policy

From the Guidelines

For a patient with chronic cystitis, I recommend a comprehensive approach including both antimicrobial therapy and lifestyle modifications, prioritizing individualized treatment based on the unique characteristics of each patient, as suggested by the 2022 updated Guideline 1. This approach should include a combination of behavioral/non-pharmacologic interventions, oral medicines, bladder instillations, procedures, and major surgery, if necessary.

  • Initial treatment should include a 7-14 day course of antibiotics such as trimethoprim-sulfamethoxazole (Bactrim) 160/800mg twice daily, nitrofurantoin (Macrobid) 100mg twice daily, or ciprofloxacin 500mg twice daily, based on urine culture and sensitivity results.
  • Patients should increase fluid intake to 2-3 liters daily, urinate frequently, avoid bladder irritants (caffeine, alcohol, spicy foods), and practice proper hygiene.
  • Behavioral modification strategies may include: altering the concentration and/or volume of urine, either by fluid restriction or additional hydration; avoidance of certain foods known to be common bladder irritants; use of an elimination diet to determine which foods or fluids may contribute to symptoms; over-the-counter products (eg, nutraceuticals, calcium glycerophosphates, phenazopyridine); techniques applied to trigger points and areas of hypersensitivity (eg, application of heat or cold over the bladder or perineum); strategies to manage IC/BPS flare-ups (eg, meditation, imagery); pelvic floor muscle relaxation; and bladder training with urge suppression, as suggested by the 2022 study on diagnosis and treatment of interstitial cystitis/bladder pain syndrome 2.
  • For postmenopausal women, vaginal estrogen therapy may help restore urogenital flora.
  • Pain management can include phenazopyridine (Pyridium) 100-200mg three times daily for short-term relief.
  • If symptoms persist despite treatment, further evaluation with cystoscopy, urodynamic studies, or referral to a urologist is warranted to rule out underlying conditions like interstitial cystitis, bladder stones, or malignancy.

From the FDA Drug Label

CLINICAL TRIALS ELMIRON® was evaluated in two clinical trials for the relief of pain in patients with chronic interstitial cystitis (IC). INFORMATION FOR PATIENTS (Patient Copy) RIMSO-50® is a sterile solution of 50% dimethyl sulfoxide (DMSO) and 50% water that has been approved by the U. S. Food and Drug Administration for use in the symptomatic relief of patients with interstitial cystitis. The patient has chronic cystitis, but the provided drug labels discuss interstitial cystitis. Since cystitis and interstitial cystitis are related but distinct conditions, and the labels do not directly address chronic cystitis, no conclusion can be drawn about the use of these medications for this specific patient's condition 3, 4, 5.

From the Research

Chronic Cystitis

  • Chronic cystitis is a condition characterized by recurring episodes of cystitis, which is a bacterial infection of the lower urinary tract 6.
  • The symptoms of chronic cystitis include pain when passing urine, urgency, haematuria, and suprapubic pain not associated with passing urine 6.
  • Recurrent cystitis is usually defined as three episodes of urinary tract infection in the previous 12 months, or two episodes in the previous 6 months 6.

Diagnosis and Treatment

  • The diagnosis of uncomplicated cystitis is usually easily made based on the clinical presentation, which includes dysuria, frequency and/or urgency without fever 7.
  • Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas 7.
  • Trimethoprim-sulfamethoxazole, nitrofurantoin monohydrate/macrocrystals, and fosfomycin trometamol are all appropriate first-line therapies for uncomplicated cystitis 8.

Prevention of Recurrent Cystitis

  • The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition 7.
  • Continuous antibiotic prophylaxis, continuous prophylaxis with methenamine hippurate, cranberry juice and cranberry products, and postcoital antibiotic prophylaxis are some of the interventions that have been studied for the prevention of recurrent cystitis 6.

Interstitial Cystitis

  • Interstitial cystitis is a chronic, severely debilitating disease of the urinary bladder, characterized by excessive urgency and frequency of urination, suprapubic pain, dyspareunia, chronic pelvic pain, and negative urine cultures 9.
  • The diagnosis of interstitial cystitis is made by cystoscopy and hydrodistention of the bladder, and glomerulations or Hunner's ulcers found at cystoscopy are diagnostic 9.
  • Oral treatments of interstitial cystitis include pentosan polysulfate, tricyclic antidepressants, and antihistamines, while intravesicular therapies include hydrodistention, dimethyl sulfoxide, and heparin, or a combination of agents 9, 10.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.